Medical Only - Claims Adjuster, Workers’ Compensation (California)

Pie Insurance; United States; Remote; USD 60,000 - 75,000; Full time

Job summary

A leading insurance provider in the United States is seeking a Medical Only - Claims Adjuster for Workers’ Compensation. This remote role will focus on managing medical-only claims, ensuring compliance with regulations, and providing an excellent customer claims experience. The ideal candidate will have at least 1 year of relevant experience and a strong commitment to customer service. Base compensation ranges from $60,000 to $75,000, along with competitive benefits and a 401k match.

Benefits

Competitive cash compensation

Equity options

Generous PTO

401k match

Parental and caregiver leave

Qualifications

• 1+ years workers’ compensation claims experience as a medical only adjuster is required.
• Experience in high volume states: CA, AZ, UT, and TX preferred.
• Demonstrated knowledge and experience in claim adjudication and medical management.

Responsibilities

• Independently handle all aspects of the workers’ compensation medical only claims.
• Provide excellent customer service to internal and external customers.
• Ensure compliance with all applicable statutory guidelines and regulations.

Skills

Communication skills

Claims adjudication

Medical management

Problem-solving

Education

High School Diploma or equivalent

Bachelor's Degree or equivalent experience

Tools

G-Suite Tools

Slack

Job description

Medical Only - Claims Adjuster, Workers’ Compensation (California)

United States

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.

Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make.

The Claims Medical Only/Lien Adjuster will play a vital role in delivering quality claim file management and an industry-leading customer claims experience. This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers.

How You’ll Do It

Claims Technical Management:

• Independently handle all aspects of the workers’ compensation medical only claims from set-up to closure.
• Conduct timely 2-point contact investigation, with focus on continued medical management, potential for lost time benefits, and claim closure as facts of the case change.
• Mitigate claim exposure while achieving the best outcome.
• Determine timely and accurate compensability decisions within statutory requirements.
• Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices.
• Timely administration of statutory medical benefits throughout the life of the claim.
• Use Utilization Review where appropriate and pay medical bills within the allotted timeframes
• Comply with all applicable statutory guidelines, rules, and regulations.
• Proactively identify and timely assign claims that meet indemnity claim conversion criteria
• Consistent and timely resolution of medical treatment to resolve and close claims
• Maintain a split inventory of Lien resolution claims, negotiating liens to appropriate resolution

Claims Customer Service:

• Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations.
• Assist as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc.
• Provide excellent customer service to internal and external customers and business partners.
• Advocate to ensure that Pie has a leading claims customer experience.
• Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes.

The Right Stuff

• High School Diploma or equivalent is required.
• Bachelor's Degree or equivalent experience with some college coursework is preferred.
• 1+ years workers’ compensation claims experience as a medical only adjuster is required.
• Experience in the following states preferred due to higher volume: CA, AZ, UT and TX
• Proficient communication (written and verbal) skills, to deliver information effectively.
• Awareness of your own tasks, and how it impacts the team and deliverables.
• Experience using G-Suite Tools, and collaboration tools like Slack is preferred.
• Demonstrated knowledge and experience in claim adjudication and medical management.
• Developing ability to analyze and take necessary action in multiple focus areas, based on several data points.
• Ability to use skills to overcome conflict and reach beneficial outcomes.
• Ability to make claim decisions to mitigate exposure while achieving the best outcome.

Base Compensation Range

$60,000 - $75,000 USD

• Competitive cash compensation
• A piece of the pie (in the form of equity)
• Generous PTO
• Future focused 401k match
• Generous parental and caregiver leave
• Our core values are more than just a poster on the wall; they’re tangibly reflected in our work

Location Information

Unless otherwise specified, this role is remote. Remote team members must live and work in the United States and have access to reliable, high-speed internet.

Pie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic.